Clinical simulators: applications and implications for rural medical education

Medical education has undergone significant changes globally. Calls for the revitalisation of centuries old pathways of learning have resulted in innovative medical curricula. Didactic modes of teaching which involved the learning of copious amounts of facts have given way to curricula that focus on the horizontal and vertical integration of basic and clinical sciences. Increasing concern for patient care and safety has led to a 'gap' between the needs of medical students to acquire necessary psychomotor skills and the safety and wellbeing of the patient. This has resulted in alternate teaching methods that include non-patient based training for the acquisition of clinical skills. The use of computerised, full-sized human simulators provides medical students with the necessary psychomotor and clinical reasoning skills in a realistic learning environment, while remaining risk free to patients. These clinical simulators are powerful learning tools that have applications at all levels of medical education across multiple disciplines, emphasising the multidisciplinary approach required in many medical situations. This article reviews the literature on medical simulation and provides the contextual basis for the establishment of a Clinical Simulation Learning Centre (CSLC) in a rural clinical school in Australia. The educational program, as well as the design, layout and equipment of the CSLC are described, as well as implications for rural practitioners. The CSLC has been a major capital investment in a relatively under-resourced part of regional Australia and has provided opportunities for ongoing education across a range of healthcare professionals in the community

'Sly grog' and 'homebrew': a qualitative examination of illicit alcohol and some of its impacts on Indigenous communities with alcohol restrictions in regional and remote Queensland (Australia)

Background: Indigenous communities in Queensland (Australia) have been subject to Alcohol Management Plans since 2002/03, with significant penalties for breaching restrictions. 'Sly grog' and 'homebrew' provide access to alcohol despite restrictions. This paper describes how this alcohol is made available and the risks and impacts involved. In affected towns and communities across a large area of rural and remote Queensland, interviews and focus groups documented experiences and views of 255 long-standing community members and service providers. Using an inductive framework, transcribed interviews were analysed to identify supply mechanisms, community and service provider responses and impacts experienced. Results: 'Homebrew' was reportedly manufactured in just a few localities, in locally-specific forms bringing locally-specific harms. However, 'sly grog' sourced from licensed premises located long distances from communities, is a widespread concern across the region. 'Sly grog' sellers circumvent retailers' takeaway liquor license conditions, stockpile alcohol outside restricted areas, send hoax messages to divert enforcement and take extraordinary risks to avoid apprehension. Police face significant challenges to enforce restrictions. On-selling of 'sly grog' appears more common in remote communities with total prohibition. Despite different motives for involvement in an illicit trade 'sly grog' consumers and sellers receive similar penalties. Conclusions: There is a need for: (a) a more sophisticated regional approach to managing takeaway alcohol sales from licensed suppliers, (b) targeted penalties for 'sly grog' sellers that reflect its significant community impact, (c) strategies to reduce the demand for alcohol and (d) research to assess the effects of these strategies in reducing harms.Michelle S. Fitts, Jan Robertson, Simon Towle, Chris M. Doran, Robyn McDermott, Adrian Miller, Stephen Margolis, Valmae Ypinazar and Alan R. Cloug

Awareness of risks of overweight among rural Australians

Abstract: INTRODUCTION: Overweight and obesity are highly prevalent in rural areas and pose significant risks to health. The aim of this study was to investigate whether the rural public in central Queensland are aware of the health risks of overweight and to determine whether their perceptions of weight status and methods used to assess weight status correspond with those of health professionals. METHODS: Adults were randomly selected from shoppers in shopping centres in Central Queensland, Australia, to self-complete a questionnaire that assessed participants' understanding of the health risks of overweight, perception of current weight, methods used to assess current weight and understanding of the concepts of body mass index (BMI) and waist-to-hip ratio (WHR). Participants were also asked to provide demographic details and self-report their height and weight. RESULTS: The majority of participants were appropriately aware that, regardless of their degree of physical activity, overweight is associated with increased risk of heart disease (92%), type 2 diabetes (83%) and stroke (83%). A large proportion were also aware of the association of overweight with sleep apnoea (69%), fertility problems (68%) and arthritis (57%) but few were aware of the link with asthma (35%) and various types of cancer (14-32%). Knowledge of the health risks of overweight did not differ greatly across the BMI spectrum, with similar beliefs expressed by those who were classified overweight or obese (based on self-reported data) and those who were not. Women were more aware of the health risks of overweight for type 2 diabetes and fertility problems, less likely to be overweight, and to more accurately perceive their weight status compared with men. The majority of participants used subjective measures to assess weight status and few used or understood BMI or WHR. CONCLUSIONS: Rural people in central Queensland appear to be well aware of the health risks of overweight but many are unable to identify overweight in themselves and few understand how to accurately gauge their weight status. This exploratory study highlights the need to educate people in these communities about accurate and objective measures to assess overweight and obesity. Further studies are needed to assess how common misperception of weight status is among rural populations in Australia and to determine whether this contributes to a higher prevalence of overweight and obesity in rural communities compared with urban areas

Identification of best evidence in medical education. Case study

Aim: Compare how different researchers performed in screening for informative evidence about medical education. Method: Six researchers with three different levels of involvement in a systematic literature review screened articles by title and (where available) abstract, and then by reading articles they had selected in full text. The reference standard was a consensus decision to include or exclude the article in the final analysis, whose results are published elsewhere. Results: The single screener most involved in the literature search, who was also the most junior member of the topic review group, achieved a sensitivity approaching 100% and a specificity of 98-100% for informative articles. She far outperformed the other researchers, all of whom had as much or more topic knowledge and greater research experience. Conclusion: It was not possible to improve on the performance of the single motivated and capable primary screener and trying to do so increased the number of uninformative articles retrieved. One interpretation is that the primary searcher was more practiced and focused on the task than her more senior colleagues, yet they tended to become worse rather than better with practice. The fact that a well informed but relatively naive person consistently outperformed her more "expert'' colleagues might suggest an alternative explanation: Given the patchy standard and qualitative nature of the evidence, perhaps experts found it harder than a novice to make reliable choices, in which case their unreliable performance reflects the nature of present day education evidence. This case study illustrates the value of quality assuring the article selection process. Given the amount of disagreement uncovered by the study, we suggest that consensus between reviewers is an important reference standard against which the performance of any single primary screener should be checked

Early practical experience and the social responsiveness of clinical education: Systematic review

Ocho imágenes de un meduloblastoma desmoplásico en un paciente de 5 años.Eight pictures of a desmoplastic medulloblastoma in a 5-year-old male patient